Non-vented vial access syringe

ABSTRACT

A syringe includes a plunger having a plunger tube with proximal and distal ends, a center tube with a center passage that extends within the plunger tube, and a balloon disposed over the center tube and sealingly fixed to at least one of the center tube and the plunger tube. The syringe also includes a barrel having a barrel tube having proximal and distal ends and an interior configured to accept a portion of the plunger, a tip fixedly coupled to the proximal end of the barrel tube, a post fixedly attached to the tip and extending within the barrel tube toward the distal end, the tip configured to partially extend into the center passage of the plunger, and a gas passage extending from a proximal end of the tip to the distal end of the post.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. application Ser. No.13/797,683, filed Mar. 12, 2013, entitled, “NON-VENTED VIAL ACCESSSYRINGE,” the disclosure of which is incorporated herein by reference inits entirety.

BACKGROUND

Field

The present disclosure generally relates to syringes and, in particular,to a syringe for extracting the contents of a sealed vial.

Description of the Related Art

Medications are often delivered in sealed vials. The medicine may be ineither liquid form, and therefore ready to use, or in a dry, powderedform that requires reconstitution prior to use. In the case of a liquidmedication, extraction of the liquid without introducing a gas into thevial results in a partial vacuum being created within the vial, whichmakes the extraction of the liquid more difficult. In the case of a drymedication, introduction of water into the vial, so as to reconstitutethe medication, results in an increased pressure within the vial, whichmakes it difficult to introduce the water as well as presenting a hazardwhen extracting the reconstituted medication.

Vials are typically provided with a septum adapted for penetration by aneedle. Vial adapters are available that include a needle, which isarranged to penetrate the septum of a vial, that is in fluidcommunication with a female needleless fitting configured to accept aneedleless male fitting of a syringe. Common needleless fittings have a“Luer taper” conforming to an International Standards Organization (ISO)standard. Certain connectors have a self-sealing feature to preventleakage of fluid from the attached vial when the syringe is decoupledfrom the fitting of the vial adapter. Certain vial adapters provide ventpaths to the ambient environment to allow ambient air to enter the vialor allow gas to be expelled from the vial to the ambient environment.Certain vial adapters include a sealed chamber that capture gas expelledfrom the vial and prevent the expelled gas from passing into the ambientenvironment.

SUMMARY

The non-vented syringe disclosed herein is adapted for use with a sealedvial, in various embodiments, so as to maintain a generally constantpressure within the vial while adding or removing liquid.

In certain embodiments, a syringe is disclosed that includes a plungerhaving a plunger tube having proximal and distal ends, a center tubecoupled to the proximal end of the plunger tube and extending within theplunger tube toward the distal end, the center tube having a centerpassage, and a balloon disposed over the center tube and sealingly fixedto at least one of the center tube and the plunger tube. The syringealso includes a barrel having a barrel tube having proximal and distalends and an interior configured to accept a portion of the plunger, atip fixedly coupled to the proximal end of the barrel tube, a postfixedly attached to the tip and extending within the barrel tube towardthe distal end, the tip configured to partially extend into the centerpassage of the plunger, and a gas passage extending from a proximal endof the tip to the distal end of the post.

In certain embodiments, a pre-filled syringe is disclosed that containsa prefill volume of a medical fluid. The syringe includes a plungerhaving a plunger tube having proximal and distal ends, a center tubecoupled to the proximal end of the plunger tube and extending within theplunger tube toward the distal end, the center tube having a centerpassage, and a balloon disposed over the center tube and sealingly fixedto at least one of the center tube and the plunger tube. The balloon andthe at least one of the center tube and the plunger tube form a gasvolume containing a gas. The syringe also includes a barrel having abarrel tube having proximal and distal ends and an interior configuredto accept a portion of the plunger, a tip fixedly coupled to theproximal end of the barrel tube, a post fixedly attached to the tip andextending within the barrel tube toward the distal end, the tipconfigured to partially extend into the center passage of the plunger,and a gas passage extending from a proximal end of the tip to the distalend of the post. The plunger is partially inserted into the barrel so asto form a liquid volume that contains the prefill amount of the medicalfluid. The balloon is able to further expand such that the gas volumeincreases by at least the prefill volume so as to be able to accept gasdisplaced from a sealed vial when the prefill volume of medical liquidis injected into the vial.

In certain embodiments, a syringe for extracting a dose volume of amedical fluid from a sealed vial is disclosed. The syringe includes aplunger having a plunger tube having proximal and distal ends, a centertube coupled to the proximal end of the plunger tube and extendingwithin the plunger tube toward the distal end, the center tube having acenter passage, and a balloon disposed over the center tube andsealingly fixed to the proximal end of the plunger tube. The balloon andthe plunger tube form a gas volume having a minimum gas capacity. Thesyringe also includes a barrel having a barrel tube having proximal anddistal ends and an interior configured to accept a portion of theplunger, a tip fixedly coupled to the proximal end of the barrel tube, apost fixedly attached to the tip and extending within the barrel tubetoward the distal end, the tip configured to partially extend into thecenter passage of the plunger, and a gas passage extending from aproximal end of the tip to the distal end of the post. The syringe isfully inserted into the barrel such that a liquid volume formed betweenthe plunger and barrel is approximately zero and the gas volume containsa quantity of gas that is greater than or equal to a maximum liquidcapacity of the liquid volume plus the minimum gas capacity.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide furtherunderstanding and are incorporated in and constitute a part of thisspecification, illustrate disclosed embodiments and together with thedescription serve to explain the principles of the disclosedembodiments. In the drawings:

FIGS. 1A-1B are cross-sections of a barrel and a plunger of an exemplarysyringe according to certain aspects of the present disclosure.

FIGS. 2A-2B are cross-sections of an exemplary syringe extracting aliquid from a vial according to certain aspects of the presentdisclosure.

FIGS. 3A-3B are cross-sections of an exemplary syringe extracting aliquid from a vial according to certain aspects of the presentdisclosure.

FIGS. 4A-4B are cross-sections illustrating an exemplary vial adapterconfigured to be used with the exemplary syringe to access the contentsof a vial according to certain aspects of the present disclosure.

DETAILED DESCRIPTION

The syringe disclosed herein is adapted for use with a sealed vial, invarious embodiments, so as to maintain a generally constant pressurewithin the vial while adding or removing liquid. In certain embodiments,the disclosed syringe accepts a flow of gas from the vial that isdisplaced by liquid being introduced into the vial by the syringe andcaptures this displaced air, so as to prevent escape of the displacedair and any entrained medication into the ambient atmosphere. In certainembodiments, the disclosed syringe includes a reservoir of sterile airand provides a flow of this sterile air into the vial to replace liquidthat is withdrawn from the vial by the syringe. The syringe may be used,in certain embodiments, directly with a vial or, in other embodiments,with a vial adapter configured to extend the liquid and gas passages ofthe syringe into the vial.

In the following detailed description, numerous specific details are setforth to provide a full understanding of the present disclosure. It willbe apparent, however, to one ordinarily skilled in the art thatembodiments of the present disclosure may be practiced without some ofthe specific details. In other instances, well-known structures andtechniques have not been shown in detail so as not to obscure thedisclosure. In the referenced drawings, like numbered elements are thesame or essentially similar. Reference numbers may have letter suffixesappended to indicate separate instances of a common element while beingreferred to generically by the same number without a suffix letter.

While the discussion herein is directed to the use of the disclosedsyringe to access the medical fluids with sealed vials, as typicallyprovided in healthcare environments, this is a non-limiting example ofhow the disclosed syringe may be used. The same system and methods maybe applied to other fields, for example the handling of radioactiveliquids, wherein exposure of a user to the contents of a sealedcontainer may present a risk.

Within this disclosure, the term “balloon” means a flexible, hollowelement that has an interior with an opening wherein sealing the openingto a surface creates a sealed internal volume. The hollow element may beformed of an elastomeric material, which can stretch under an appliedpressure, or a non-elastomeric material that does not stretch to asignificant degree under an operational pressure. The balloon may beformed as an elongated cylinder with a closed end opposite to an openingbut may, in certain embodiments, be provided in other shapes or forms,for example a sphere or as a flat sheet sealing a rigid enclosure. Aballoon may have folds or pleats formed in a portion of the material.

FIGS. 1A-1B are cross-sections of a barrel 101 and a plunger 102 of anexemplary syringe 100 according to certain aspects of the presentdisclosure. As shown in FIG. 1A, the barrel 101 has a barrel tube 110with an interior 111 open at a distal end. The tip 112 is fixedlycoupled to and seals a proximal end of the barrel tube 110. In certainembodiments, the external surface 113 of the tip 112 has a conical form.In certain embodiments, the external surface 113 comprises a male Luerfitting. A post 114 is fixedly attached to a distal end of the tip 112and extends within the barrel tube 110 toward the distal end. A gaspassage 116 extends from a proximal end of the tip 112 to the distal endof the post 114. A liquid passage 118 extends from the interior of thebarrel tube 110 to an exterior surface of the tip 112. In certainembodiments, the liquid passage 118 opens on the surface 113 proximateto the distal end of the surface 113. In certain embodiments, the distalend of the tip 112 is generally formed as a cone and the liquid passage118 enters the interior of the barrel tube 110 at an inner edge of theconical end of the tip 112 such that all of a fluid within the interiorof the barrel tube 110 may drain, when oriented as shown in FIG. 1,through the liquid passage 118.

FIG. 1B shown that the plunger 102 has a plunger tube 150 having aninterior 151 open at a distal end and closed at a proximal end. A centertube 152 is fixedly coupled to the proximal end of the plunger tube 150and extends within the plunger tube 150 toward the distal end. A centerpassage 162 extends from the distal end of the center tube 152 to theproximal end of the plunger 102 and is configured to allow the post 114to slide within the center passage 162 when the plunger 102 is insertedinto the barrel 101. A flexible balloon 154 is disposed over the centertube 152 and is sealingly fixed to the closed end of the plunger tube150, thereby forming an interior gas volume 164. A vent cap 156 coversthe distal end of the plunger tube 150 and has one or more vent holes158 to allow ambient air to pass into or out of the interior 151 of theplunger tube 150 while protecting the balloon 154 from damage.

A sealing member 160 is formed on the proximal end of the plunger 102and seals to the barrel 101. In certain embodiments, the proximal sideof the sealing member 160 has a shape that is complementary to theconical shape of the distal end of the tip 112. The sealing member 160sealingly engages the interior surface of the barrel tube 110 when theplunger 102 is inserted into the barrel 101 so as to define a liquidvolume of the syringe 100, as is discussed further with respect to FIGS.2A, 2B. The sealing member 160 also forms a seal with the post 114.

FIGS. 2A-2B are cross-sections of an exemplary syringe 100 injecting aliquid 10 into a vial 80 according to certain aspects of the presentdisclosure. The syringe 100 has a barrel 101 and a plunger 102 thatgenerally are configured as discussed with respect to FIGS. 1A, 1B.

In FIG. 2A, the syringe 100 is shown with the tip 112 inserted though aseptum 14 in the cap 12 of an example vial 80 that is used to illustratethe features of the syringe 100. In this example, the interior volume 16of the vial 80 is partially filled with a powdered medication 30 and theremaining space is filled with a gas 32. For other types of vials havingseptums adapted for penetration by a needle, a vial adapter may becoupled to the vial 80 to provide a female needleless fitting suitableto accept the tip 112, as is discussed in greater detail with respect toFIGS. 4A, 4B. In certain embodiments, the tip 112 of the syringe 100 mayhave a needle (not shown in FIG. 2A) within one or both passages 116 and118 passing through portions of the needle. Other arrangements of tipsfor obtaining access to the interior of a sealed vial of various typeshaving liquid and gas passages arranged as disclosed herein will beapparent to those of skill in the art.

In FIG. 2A, the plunger 102 is partially inserted into the barrel 101 soas to form a liquid volume filled with a liquid 10, for example sterilewater. The sealing member 160 forms a seal with the interior surface ofthe barrel tube 110 and with the post 114 to define this liquid volume.In this example, the balloon 154 has a minimum volume of the gas volume164 and is filled with a sterile gas 20.

FIG. 2B depicts the syringe of FIG. 2A after the plunger 102 has beenpushed in the proximal direction as indicated by the arrow “A” withrespect to the barrel 101, thereby injecting a portion 10′ of the liquid10 through the liquid passage 118 into the vial 80, leaving a remainingportion 10″. As the vial 80 is sealed, the volume 16 is fixed andaddition of a non-compressible liquid would increase the pressure withinthe vial 80 if there was no path to vent a portion of the gas or liquidfrom the vial 80. With the exemplary syringe 100, the gas passage 116allows a portion 32′ of the gas 32 within the vial 80 to flow from thevial 80 into the interior 164 of the balloon 154. As the balloon 154 isexpandable and exposed to the ambient environment through the vent holes158, the pressures within the interior 164 of the balloon 154 and withinthe vial 80 remain approximately constant and at ambient pressure. Thus,the pressure within the vial 80 remains approximately at ambientpressure during the injection of the liquid 10 into the vial 80 toreconstitute the powdered medication 30.

A benefit of capturing the expelled portion 32′ within a sealed volume164 is that the user is not exposed to the contents of the vial 80. Forcertain medications, for example an oncology medication, the puremedication 30 may be toxic and the expelled portion 32′ may entrain someof the medication 30 in either powdered or liquid form. Since theballoon 154 is sealed to the plunger tube 152 and expands as the portion32′ enters the volume 164 to produce a gas volume 20″ within theballoon, none of the expelled portion 32′ of the gas passes into theambient environment. In certain embodiments, the balloon 154 is capableof expanding to a volume 164 that is greater than or equal to theminimum volume of the balloon 154 plus the maximum volume of liquid thatthe syringe 100 can contain.

FIGS. 3A-3B are cross-sections of the exemplary syringe 100 of FIG. 1extracting a liquid 40 from a vial 80 according to certain aspects ofthe present disclosure. In certain embodiments, the sequence of eventsdepicted in FIGS. 3A, 3B may occur immediately after the powderedmedication 30 is reconstituted with liquid 10 to form the liquidmedication 40, as shown in the sequence of FIGS. 2A, 2B. In certainembodiments, a vial 80 may be provided with a liquid medication 40 andso the process may be initiated as shown in FIG. 3A.

In FIG. 3A, a syringe 100 is shown with the tip 112 inserted though aseptum 14 in the cap 12 of an example vial 80, as discussed above withrespect to FIG. 2A. The plunger 102 is, in this example, fully depressedwithin the barrel 101. The volume 164 within the balloon 154 contains avolume of gas 20″ that, in this example, is the same as the volume ofgas 20″ within the volume 164 of FIG. 2B. In this example, the liquidvolume within the syringe 100 in the configuration of FIG. 3A isapproximately zero.

FIG. 3B depicts the syringe 100 after the plunger 102 has been withdrawna certain distance from the barrel 101 as indicated by the arrow “B.” Aportion 40′ of the liquid 40 has been drawn from the vial 80 through theliquid passage 118 and into the interior of the barrel 110, leaving aremainder 40″ within the vial 80. As the liquid 40 leaves the vial 80, apartial vacuum is created within the vial 80 that draws a portion 20′ ofthe gas 20″ from the balloon 152 through the central passage 116 intothe interior of the vial 80, leaving a remainder 20′″ in the gas volume164. The pressure within the gas volume 164 of balloon 154 remainsapproximately at ambient pressure, since the balloon 154 is exposed tothe ambient atmosphere through vent holes 158, and ambient air flows in,as indicated by arrow 22, as the volume 164 decreases. As the interior16 of the vial 80 is connected through the gas passage 116 to the volume164, the interior 16 also remains at approximately ambient pressure. Thevolume 164 may be sized to contain enough gas 20″ to allow the fullcapacity of the syringe 100 to be drawn from the vial 80.

FIGS. 4A-4B are cross sections of an example vial adapter 200 configuredfor use with the syringe 100 according to certain aspects of the presentdisclosure. A needle 220 is fixed to a proximal side of the adapter 200.The needle 220 has two passages—a gas passage 225 and a liquid passage230. The vial adapter 200 has a cavity 210 that is, in certainembodiments, configured as a female Luer fitting. The cavity 210 has arecess 235 that, in this example, extends around the cavity 210 at thelocation corresponding to the position of the opening of the liquidpassage 118. This embodiment of recess 235 allows the syringe 100 to beoriented in any rotational position while maintaining fluid coupling ofthe recess 235 and the fluid passage 118. The recess 235 is connected tothe liquid passage 230 and the gas passage 225 is connected to aproximal end of the cavity 210. The adapter 200 also has a capturefeature 215 that is configured to engage a lid 12 of a sealed via 80,such as is known to those of skill in the art. In this example, thesyringe 100 contains a liquid 40.

FIG. 4B depicts the vial adapter 200 engaged with a vial 80 and asyringe 100 coupled to the vial adapter 200. It can be seen that the gaspassage 116 of the syringe 100 is coupled to the interior 16 of the vial80 through the gas passage 225 and the liquid volume of the syringe 100is coupled to the interior 16 of the vial 80 through the liquid passage230. When held in an inverted position, as shown in FIG. 4B, the liquid40 may be drawn into the liquid volume of the syringe 100 through theliquid passage 230 while gas passes from the syringe 100 through the gaspassages 116 and 225 into the vial, as previously discussed with respectto FIGS. 3A, 3B.

It can be seen that the disclosed embodiments of the syringe provide thecapability to inject a liquid into a sealed vial or to extract a liquidfrom a vial while maintaining the pressure within the vial atapproximately ambient pressure. This reduces the effort required toinject or extract a liquid. In certain disclosed embodiments, thesyringe reduces the risk of a user being exposed to a hazardous liquidcontained in a vial by capturing the gas that is displaced from the vialwhen a liquid is introduced into the vial, for example to reconstitute apowdered medication. In certain disclosed embodiments, the syringereduces the risk of contamination of the fluid in the vial by providingsterile gas into the vial from a reservoir within the syringe as liquidis drawn out of the vial, thereby avoiding the need to allow non-sterileambient air into the vial.

The previous description is provided to enable any person skilled in theart to practice the various aspects described herein. While theforegoing has described what are considered to be the best mode and/orother examples, it is understood that various modifications to theseaspects will be readily apparent to those skilled in the art, and thegeneric principles defined herein may be applied to other aspects. Thus,the claims are not intended to be limited to the aspects shown herein,but is to be accorded the full scope consistent with the languageclaims, wherein reference to an element in the singular is not intendedto mean “one and only one” unless specifically so stated, but rather“one or more.” Unless specifically stated otherwise, the terms “a set”and “some” refer to one or more. Pronouns in the masculine (e.g., his)include the feminine and neuter gender (e.g., her and its) and viceversa. Headings and subheadings, if any, are used for convenience onlyand do not limit the invention.

To the extent that the term “include,” “have,” or the like is used inthe description or the claims, such term is intended to be inclusive ina manner similar to the term “comprise” as “comprise” is interpretedwhen employed as a transitional word in a claim.

It is understood that the specific order or hierarchy of steps in theprocesses disclosed is an illustration of exemplary approaches. Basedupon design preferences, it is understood that the specific order orhierarchy of steps in the processes may be rearranged. Some of the stepsmay be performed simultaneously. The accompanying method claims presentelements of the various steps in a sample order, and are not meant to belimited to the specific order or hierarchy presented.

Terms such as “top,” “bottom,” “front,” “rear” and the like as used inthis disclosure should be understood as referring to an arbitrary frameof reference, rather than to the ordinary gravitational frame ofreference. Thus, a top surface, a bottom surface, a front surface, and arear surface may extend upwardly, downwardly, diagonally, orhorizontally in a gravitational frame of reference.

A phrase such as an “aspect” does not imply that such aspect isessential to the subject technology or that such aspect applies to allconfigurations of the subject technology. A disclosure relating to anaspect may apply to all configurations, or one or more configurations. Aphrase such as an aspect may refer to one or more aspects and viceversa. A phrase such as an “embodiment” does not imply that suchembodiment is essential to the subject technology or that suchembodiment applies to all configurations of the subject technology. Adisclosure relating to an embodiment may apply to all embodiments, orone or more embodiments. A phrase such an embodiment may refer to one ormore embodiments and vice versa.

The word “exemplary” is used herein to mean “serving as an example orillustration.” Any aspect or design described herein as “exemplary” isnot necessarily to be construed as preferred or advantageous over otheraspects or designs.

All structural and functional equivalents to the elements of the variousaspects described throughout this disclosure that are known or latercome to be known to those of ordinary skill in the art are expresslyincorporated herein by reference and are intended to be encompassed bythe claims. Moreover, nothing disclosed herein is intended to bededicated to the public regardless of whether such disclosure isexplicitly recited in the claims. No claim element is to be construedunder the provisions of 35 U.S.C. §112, sixth paragraph, unless theelement is expressly recited using the phrase “means for” or, in thecase of a method claim, the element is recited using the phrase “stepfor.”

What is claimed is:
 1. A syringe comprising: a barrel comprising (a) abarrel tube having a proximal end, a distal end, and an interior; (b) apost coupled to the proximal end and extending partially into theinterior toward the distal end; (c) a first fluid passage extending fromthe proximal end of the barrel tube into the interior; and (d) a secondfluid passage extending from the proximal end of the barrel tube throughthe post; and a plunger comprising (a) a plunger tube partially disposedin the barrel tube such that the post extends into a proximal end of theplunger tube and (b) a flexible member coupled to the proximal end ofthe plunger tube, wherein the flexible member is in fluid communicationwith the second fluid passage; wherein the proximal end of the barreltube and the proximal end of the plunger tube define therebetween afirst fluid volume that is configured to hold fluid and is in fluidcommunication with the first fluid passage.
 2. The syringe of claim 1,wherein a center tube is coupled to the proximal end of the plungertube, the center tube having center passage configured to receive thepost.
 3. The syringe of claim 1, wherein the proximal end of the barreltube comprises a tip, the first fluid passage and the second fluidpassage extending through to an exterior surface of the tip.
 4. Thesyringe of claim 1, wherein the first fluid volume varies varyingbetween zero and a maximum first fluid volume capacity, and the flexiblemember and the plunger tube form a second fluid volume varying between aminimum second fluid volume capacity and a maximum second fluid volumecapacity that is greater than or equal to the maximum first fluid volumecapacity plus the minimum second fluid volume capacity.
 5. The syringeof claim 4, wherein the first fluid volume contains a first fluid andthe second fluid volume contains a gas.
 6. The syringe of claim 4,wherein the plunger is disposed within the barrel such that the firstfluid volume is approximately zero and the second fluid volume isgreater than or equal to the maximum first fluid volume capacity plusthe minimum second fluid volume capacity.
 7. The syringe of claim 4,wherein the plunger is disposed within the barrel such that the firstfluid volume contains a prefill volume of first fluid and the flexiblemember is able to further expand such that the second fluid volumefurther increases by at least the prefill volume.
 8. The syringe ofclaim 1, wherein the tip comprises a male Luer fitting.
 9. The syringeof claim 1, wherein a distal end of the plunger tube comprises a ventcap having at least one vent hole.
 10. The syringe of claim 1, whereinthe plunger further comprises a sealing member attached at the proximalend, the sealing member having an external surface that sealinglyengages an interior surface of the barrel tube when the plunger isinserted into the barrel so as to define the first fluid volume of thesyringe.
 11. A method of extracting a dose volume of a medical fluidfrom a sealed vial using a syringe, the syringe comprising: providing abarrel comprising (a) a barrel tube having a proximal end, a distal end,and an interior; (b) a post coupled to the proximal end and extendingpartially into the interior toward the distal end; (c) a first fluidpassage extending from the proximal end of the barrel tube into theinterior; and (d) a second fluid passage extending from the proximal endof the barrel tube through the post; and providing a plunger comprising(a) a plunger tube partially disposed in the barrel tube such that thepost extends into a proximal end of the plunger tube and (b) a flexiblemember coupled to the proximal end of the plunger tube, wherein theflexible member is in fluid communication with the second fluid passage;wherein the proximal end of the barrel tube and the proximal end of theplunger tube define therebetween a first fluid volume that is configuredto hold fluid and is in fluid communication with the first fluidpassage; fluidly coupling the first fluid passage and the second fluidpassage with a vial; advancing the plunger toward the vial such that afirst fluid is expelled from within the first fluid volume through thefirst fluid passage, such that the expelled fluid displaces a secondfluid within the vial, the second fluid being received through thesecond fluid passage into the flexible member.
 12. The method of claim11, further comprising retracting the plunger away from the vial suchthat the first fluid is drawn through the first fluid passage into thefirst fluid volume, and the second fluid is expelled through the secondfluid passage into the vial.
 13. The method of claim 11, furthercomprising filling the first fluid volume with a liquid prior to fluidlycoupling the first fluid passage and the second fluid passage to a vial.14. The method of claim 11, wherein the second fluid being receivedthrough the second fluid passage into the flexible member comprises agas.
 15. The method of claim 11, further comprising receiving the postin a center tube having a center passage, the center tube being coupledto the proximal end of the plunger tube.
 16. The method of claim 11,wherein fluidly coupling the first fluid passage and the second fluidpassage comprises inserting a tip at the proximal end of the barrel tubeinto the vial, wherein the first fluid passage and the second fluidpassage extend through to an exterior surface of the tip.